Modulating Mechanisms in Patients With Chronic Subjective Tinnitus and/or Chronic Pain

Not Applicable

Completed

• Conditions: Tinnitus; Pain
• Interventions: Diagnostic Test: Self-reported signs of central sensitization; Diagnostic Test: Objective signs of central sensitization; Diagnostic Test: Audiological outcome measures (audiometry, tinnitus analysis, uncomfortable loudness) in tinnitus patients with and without pain; Diagnostic Test: Cognitive functioning; Diagnostic Test: Listening effort; Diagnostic Test: Self-reported measure of pain processing; Diagnostic Test: Self-reported psychological factors; Diagnostic Test: Self-reported lifestyle factors; Diagnostic Test: Self reported neck pain related disability; Diagnostic Test: Self-reported quality of life; Diagnostic Test: Self-reported tinnitus severity and impact on daily life; Diagnostic Test: Self-reported tinnitus characteristics; Diagnostic Test: Self-reported hyperacusis

• Registration Number: NCT05186259
• Lead Sponsor: University Ghent

Brief Summary

This is a cross-sectional investigation into modulating mechanisms in patients with chronic subjective tinnitus, which will compare 4 patient groups namely chronic tinnitus with chronic pain, chronic tinnitus without chronic pain, chronic pain without tinnitus and healthy controls.

Detailed Description

The first aim is to investigate differences in pain-related factors, psychological factors, lifestyle factors and tinnitus-related factors in patients with chronic subjective tinnitus and the comparison with patients suffering from both chronic subjective tinnitus and chronic musculoskeletal pain, chronic musculoskeletal pain only and healthy controls. The primary outcome measures will be pain-related factors and correlations will also be calculated between pain-related factors on the one hand and psychological factors, lifestyle factors and tinnitus-related factors on the other hand.

A second aim is to assess contributing factors to tinnitus severity (measured by the Tinnitus Functional Index) in patients with tinnitus with or without chronic pain. Contributing factors will include pain-related factors, psychological factors, lifestyle factors, and tinnitus-related factors, audiological factors, cognitive factors.

* Pain-related factors include:

1. Self-perceived symptoms of central sensitization by means of the Central Sensitization Inventory: The Central Sensitization Inventory is a self-report questionnaire that assesses clinical symptoms indicative for central sensitization.

2. Experimental measures of central sensitization: Quantitative Sensory Testing Quantitative Sensory Testing (QST) is a psychophysiological assessment of sensory pathways including mechanicaldetection and pain thresholds, cutaneous heat detection and pain thresholds, and endogenous pain facilitation and inhibition.

3. Self-reported pain processing by means of the Pain Catastrophizing Scale

4. Self-reported neck pain related disability by means of the Neck Disability Index

* Psychological factors include:

Self-reported stress, anxiety and depression (Depression, Anxiety and Stress Scale_21 and Beck Depression Inventory), resilience (Connor Davidson Resilience Scale), personality (Big Five Index)

\*Lifestyle factors include:

Self-reported physical activity (Baecke Questionnaire), self-reported sleep quality (Pittsburgh Sleep Quality Index) and self-reported insomnia severity (Insomnia Severity Index), self-reported quality of life (SF-36)

\*Tinnitus-related factors include:

Self-reported tinnitus severity and impact (Tinnitus Functional Index), self-reported hyperacusis (Hyperacusis Questionnare), self-reported tinnitus characteristics (Tinnitus Sample Case History Questionnaire)

* Cognitive factors include:

1. Verbal working memory capacity and processing speed (Letter-number sequencing task)

2. Attention span (detecting letters-task (COTESS))

3. Cognitive flexibility and inhibition (Auditory Stroop task)

4. Listening effort (Modified version of the behavioral listening effort test based on a dual-task paradigm by Degeest, Keppler \& Corthals (2018))

* Audiological factors include:

1. Hearing thresholds (Pure tone audiometry)

2. Psychoacoustic features of tinnitus (tinnitus pitch, loudness, masking ability, and residual inhibition using same devices as for pure tone audiometry)

3. Uncomfortable Loudness (using same devices as for pure tone audiometry)

Study Timeline

• Study First Submitted: 2021-11-24
• Study Start: 2021-12-21
• Study First Submitted QC: 2021-12-22
• Study First Posted: 2022-01-11
• Primary Completion: 2022-04-01
• Study Completion: 2022-04-01
• Status Verified: 2024-01
• Last Update Submitted: 2024-01-08
• Last Update Posted: 2024-01-09

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 135

Inclusion Criteria

• Chronic subjective tinnitus patients without chronic pain:

  • Aged between 18-65 years
  • Chronic subjective tinnitus (> 3 months during most of the days (4 or more)and for more than 5 minutes/day)
  • Speaking and understanding Dutch fluently

• Chronic subjective tinnitus patients with chronic pain:

  • Aged between 18-65 years
  • Chronic subjective tinnitus (> 3 months during most of the days (4 or more)and for more than 5 minutes/day)
  • Speaking and understanding Dutch fluently
  • Persistent musculoskeletal pain lasting more than 3 months
  • Mean pain intensity of more than 3 of 10 on a numeric pain rating scale during the preceding month (the cutoff for clinically relevant pain)

• Chronic ideopathic neck pain:

  • Aged between 18-65 years
  • Persistent neck pain lasting more than 3 months
  • Mean pain intensity of more than 3 of 10 on a numeric pain rating scale during the preceding month (the cutoff for clinically relevant pain)

• Healthy controls:

  • Aged between 18-65 years

Exclusion Criteria

• Chronic subjective tinnitus with/without chronic pain:

  • Objective tinnitus
  • Subjective tinnitus caused by clear causes such as tumor, trauma, vascular dysfunction, neurological disorder, pulsatile tinnitus
  • Vertigo (Menière's disease, BPPV,...)
  • Deafness
  • Progressive middle ear pathology
  • Intracranial pathologies
  • Subjects with prior otologic surgery (for example stapedotomy), active outer or middle ear pathology
  • History of head, neck or shoulder trauma or surgery (< 5 years, or remaining complaints)
  • A history of whiplash trauma
  • Major depression or psychiatric illness (diagnosed by a psychiatrist and being in medicamental or psychiatric treatment)
  • Life threatening, metabolic, cardiovascular, neurologic, systemic diseases
  • Diagnosis of fibromyalgia/chronic fatigue syndrome
  • Pregnancy or given birth in the preceding year
  • Dyslexia, dyscalculia, AD(H)D, language/communication disorder

• Chronic subjective tinnitus without chronic pain (additional exclusion criteria):

  • No history of chronic pain
  • No pain condition in the last 6 months for which treatment was sought
  • No pain in any region > 2/10 on the testing day

• Chronic ideopathic neck pain:

  • Ever experienced whiplash trauma or other form of trauma to the head, neck, or upper quadrant
  • Specific causes of neck pain, such as cervical hernias with clinical symptoms
  • Major depression or psychiatric illness (diagnosed by a psychiatrist and being in medicamental or psychiatric treatment)
  • Life threatening, metabolic, cardiovascular, neurologic, systemic diseases
  • Diagnosis of fibromyalgia/chronic fatigue syndrome
  • A history of neck, head or shoulder girdle surgery
  • A history of whiplash trauma
  • Pregnancy or given birth in the preceding year
  • Diagnosis of any TMD, according to the Research Diagnostic Criteria for TMD (RDC/TMD); or concomitant diagnosis of primary headache

• Healthy controls:

  • Any form of tinnitus and/or hyperacusis
  • Experiencing any type of pain during at least 8 consecutive days with an NRS higher than 2/10 in the preceding year
  • Reported pain on the day of testing (VAS higher than 2/10)
  • Vertigo (Menière's disease, BPPV,...)
  • Deafness
  • History of head, neck or shoulder trauma or surgery (< 5 years, or remaining complaints)
  • Wearing a hearing aid device, implant, noise generators or receiving neuromodulation therapy
  • Intracranial pathologies
  • History of head, neck or shoulder trauma or surgery (< 5 years, currently no complaints)
  • Major depression or psychiatric illness (diagnosed by a psychiatrist and being in medicamental or psychiatric treatment)
  • Life threatening, metabolic, cardiovascular, neurologic, systemic diseases
  • A history of whiplash trauma
  • Diagnosis of fibromyalgia/chronic fatigue syndrome
  • Pregnancy or given birth in the preceding year

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Patients with chronic tinnitus	Self-reported psychological factors	Patients with chronic subjective tinnitus (\> 3 months)
Patients with chronic tinnitus	Self-reported tinnitus characteristics	Patients with chronic subjective tinnitus (\> 3 months)
Patients with chronic idiopathic neck pain	Self-reported signs of central sensitization	Patients with chronic idiopathic neck pain (\> 3 months)
Patients with chronic tinnitus and chronic musculoskeletal pain	Self-reported quality of life	Patients with chronic tinnitus and chronic musculoskeletal pain (\> 3 months)
Patients with chronic tinnitus	Listening effort	Patients with chronic subjective tinnitus (\> 3 months)
Patients with chronic tinnitus	Self-reported tinnitus severity and impact on daily life	Patients with chronic subjective tinnitus (\> 3 months)
Patients with chronic idiopathic neck pain	Self-reported psychological factors	Patients with chronic idiopathic neck pain (\> 3 months)
Patients with chronic tinnitus	Objective signs of central sensitization	Patients with chronic subjective tinnitus (\> 3 months)
Patients with chronic tinnitus	Audiological outcome measures (audiometry, tinnitus analysis, uncomfortable loudness) in tinnitus patients with and without pain	Patients with chronic subjective tinnitus (\> 3 months)
Patients with chronic tinnitus	Cognitive functioning	Patients with chronic subjective tinnitus (\> 3 months)
Patients with chronic tinnitus	Self-reported lifestyle factors	Patients with chronic subjective tinnitus (\> 3 months)
Patients with chronic tinnitus	Self-reported quality of life	Patients with chronic subjective tinnitus (\> 3 months)
Patients with chronic idiopathic neck pain	Self-reported lifestyle factors	Patients with chronic idiopathic neck pain (\> 3 months)
Patients with chronic idiopathic neck pain	Objective signs of central sensitization	Patients with chronic idiopathic neck pain (\> 3 months)
Patients with chronic idiopathic neck pain	Self reported neck pain related disability	Patients with chronic idiopathic neck pain (\> 3 months)
Patients with chronic tinnitus and chronic musculoskeletal pain	Listening effort	Patients with chronic tinnitus and chronic musculoskeletal pain (\> 3 months)
Patients with chronic tinnitus and chronic musculoskeletal pain	Self-reported lifestyle factors	Patients with chronic tinnitus and chronic musculoskeletal pain (\> 3 months)
Patients with chronic tinnitus and chronic musculoskeletal pain	Self-reported hyperacusis	Patients with chronic tinnitus and chronic musculoskeletal pain (\> 3 months)
Patients with chronic tinnitus	Self-reported signs of central sensitization	Patients with chronic subjective tinnitus (\> 3 months)
Patients with chronic tinnitus	Self-reported hyperacusis	Patients with chronic subjective tinnitus (\> 3 months)
Patients with chronic idiopathic neck pain	Self-reported measure of pain processing	Patients with chronic idiopathic neck pain (\> 3 months)
Patients with chronic tinnitus and chronic musculoskeletal pain	Self-reported signs of central sensitization	Patients with chronic tinnitus and chronic musculoskeletal pain (\> 3 months)
Patients with chronic tinnitus and chronic musculoskeletal pain	Self reported neck pain related disability	Patients with chronic tinnitus and chronic musculoskeletal pain (\> 3 months)
Healthy controls	Objective signs of central sensitization	Healthy controls without tinnitus or pain complaints
Healthy controls	Self-reported signs of central sensitization	Healthy controls without tinnitus or pain complaints
Patients with chronic tinnitus and chronic musculoskeletal pain	Audiological outcome measures (audiometry, tinnitus analysis, uncomfortable loudness) in tinnitus patients with and without pain	Patients with chronic tinnitus and chronic musculoskeletal pain (\> 3 months)
Patients with chronic idiopathic neck pain	Self-reported quality of life	Patients with chronic idiopathic neck pain (\> 3 months)
Patients with chronic tinnitus and chronic musculoskeletal pain	Objective signs of central sensitization	Patients with chronic tinnitus and chronic musculoskeletal pain (\> 3 months)
Patients with chronic tinnitus and chronic musculoskeletal pain	Self-reported psychological factors	Patients with chronic tinnitus and chronic musculoskeletal pain (\> 3 months)
Patients with chronic tinnitus and chronic musculoskeletal pain	Cognitive functioning	Patients with chronic tinnitus and chronic musculoskeletal pain (\> 3 months)
Patients with chronic tinnitus and chronic musculoskeletal pain	Self-reported measure of pain processing	Patients with chronic tinnitus and chronic musculoskeletal pain (\> 3 months)
Healthy controls	Self-reported quality of life	Healthy controls without tinnitus or pain complaints
Patients with chronic tinnitus and chronic musculoskeletal pain	Self-reported tinnitus severity and impact on daily life	Patients with chronic tinnitus and chronic musculoskeletal pain (\> 3 months)
Patients with chronic tinnitus and chronic musculoskeletal pain	Self-reported tinnitus characteristics	Patients with chronic tinnitus and chronic musculoskeletal pain (\> 3 months)
Healthy controls	Self-reported lifestyle factors	Healthy controls without tinnitus or pain complaints
Healthy controls	Self-reported psychological factors	Healthy controls without tinnitus or pain complaints

Primary Outcome Measures

Name	Time	Method
Between-group differences in mechanical pain sensitivity by means of pressure detection and pain thresholds (expressed in kgf)	At baseline	Pain sensitivity will be assessed by a mechanical stimulus, which is given by the tester with a digital pressure algometer (FDX; Wagner Instruments) at a rate of 1 kg pressure rise per second. The participant is asked to say 'yes' if the point was reached when the pressure stimulus causes a sensation of pain (detection threshold), the tester continues giving pressure until the patient says 'yes' for a second time indicating the feeling of pain reached a 6/10 of the NRS (pain threshold). T Two consecutive measurements with a break of 30 seconds are performed.; This protocol is performed at 5 standardized body locations, being: C5-C cervical joint, N. Trigeminus, M. Masseter, M. Extensor carpi radialis longus, M. Tibialis Anterior

Secondary Outcome Measures

Name	Time	Method
Tinnitus analysis	At baseline	Tinnitus analysis Psychoacoustic features of tinnitus will be determined using the same equipment that was used for pure tone audiometry. The tinnitus analysis included determining.
Audiometric assessments	At baseline	Audiometry Pure tone audiometry according to the modified Hughson-Westlake method will be performed. For air conduction, pure tone thresholds will be determined at octave frequencies from 0.25 to 8 kHz and at half-octave frequencies 3 and 6 kHz (DD45 audiometric headset, Calisto audiometer, Interacoustics).; For each ear separately, hearing thresholds (using tonal luminal audiometry) and uncomfortable loudness (UCL) levels were determined on all octave frequencies between 250 and 8000 Hertz (Hz). Based on the audiometric thresholds and UCL levels, the Johnson Hyperacusis Quotient.
Between-group differences in heat pain sensitivity by means of heat detection and pain thresholds (expressed in °)	At baseline	Heat stimuli are given using the CHEPS PATHWAY system (Medoc). This probe is placed on the skin at the 5 standardized locations. It provides a heat stimulus that rises at a rate of 1°C/second.; Using a dual response button, the participant has to indicate when the heat sensation changes into a pain sensation by pressing a blue button (detection threshold). The temperature keeps rising after the blue button is pressed. If the patient scores the pain sensation resulting from the heat stimulus as a 6/10 on the NRS they have to press the red button. At that moment, the temperature of the thermode goes back to the baseline temperature of 32°C. When the baseline temperature is reached, a second heat stimulus is given after a 15 second break. 3 consecutive trials will be performed.; This protocol is performed at 5 standardized body locations, being: C5-C cervical joint, N. Trigeminus, M. Masseter, M. Extensor carpi radialis longus, M. Tibialis Anterior
Between-group differences in endogenous pain facilitation by means of a temporal summation protocol (expressed in pain scores (numeric rating scales, NRS)	At baseline	Temporal Summation is performed with the Contact Heat-Evoked Potential Stimulator (CHEPS) model. Temporal summation is evaluated at the M. tibialis anterior and the M. extensor carpi radialis longus.; The temperature corresponding with the mean score of the 6/10 NRS score (heat pain threshold) from the corresponding body part is used as the painful stimulus. Ten stimuli from the same heat are given to the participant with a thermode. After stimulus 1, 5 and 10 a beep sound is heard. At these moments the participant has to score the pain that they experience from the previous stimulus on the NRS from 0 to 10. Between stimuli the temperature goes back to the baseline temperature of 32°C. The velocity of the heating is 70°C/second and the velocity of the cooling down is 40°/second. Each stimulus is 0.5 seconds long with a frequency of 0.5 Hz.
Between-group differences in self-reported signs of central sensitization by means of the Dutch version of the Central Sensitization Inventory (questionnaire)	At baseline	The Central Sensitization Inventory measures the somatic and emotional symptoms commonly associated with central sensitization. It consists of two parts, one measuring 25 symptoms, the other asks whether patients have been previously diagnosed with ten specific diagnoses. A cut off of 40 out of 100 is used to determine the presence of self-reported signs of central sensitization (the higher the score, the higher the severity).
Between-group differences in endogenous pain inhibition by means of conditioned pain modulation protocol (expressed in kgf and °)	At baseline	Conditioned pain modulation is tested by asking the participant to put their non- non-dominant or non-painful dominant hand (up to the wrist joint) in a water bath of 45,5°C for 1 minute. This is the conditioning stimulus. After this, a PPT measurement is performed to measure pressure detection and pain thresholds again, at the level of the M. extensor carpi radialis longus. Two consecutive measurements of the PPTs are being performed with a 30 seconds interval in between. Thereafter, the non-dominant or non-painful hand is placed in the hot water for another minute and after this minute, heat detection and pain thresholds are evaluated again at the M. extensor carpi radialis longus. Both pressure and heat are the testing stimulus.; Also, the NRS score (0-10) for the water was asked to know if they perceived the water as a high enough pain stimulus.
Between-group differences in self-reported lifestyle factors	At baseline	The Insomnia Severity Index (ISI) was used to assess the patient's perception of insomnia severity. The ISI consists of seven items assessing the severity of sleep onset and sleep maintenance difficulties (both nocturnal and early morning awakenings), satisfaction with current sleep pattern, interference with daily functioning, notice ability of impairment attributed to the sleep problem and degree of distress or concern caused by the sleep problem. The maximal score ranges between 0 and 28 and higher scores indicate more severe insomnia.
Between-group differences in self-reported psychological factors	At baseline	The Big Five Index 2 (BFI-2) was used to quantify five traits of personality, namely agreeableness, conscientiousness, extraversion, neuroticism, and openness. The BFI-2 consists of 15 facets, describing different features of each trait
Between-group differences in self-reported quality of life	At baseline	Self-reported health-related quality of life will be evaluated using the SF- 36. This self-report questionnaire consists of 36 items that can be clustered into eight subscales: physical functioning, role limitations due to physical problems, bodily pain, general health, vitality, social functioning, role limitations due to emotional problems, and mental health. The summation of all subscales provides the total score (0-800).
Between-group differences in self-reported tinnitus related measures	At baseline	The Dutch version of the Hyperacusis Questionnaire (HQ) will be used for the quantification and characterization of hyperacusis. The HQ consists of 14 items with a total score ranging between 0 and 42, a score greater than 28 is considered to represent auditory hypersensitivity or hyperacusis.
Between-group differences in self-reported neck pain related measures	At baseline	Neck pain catastrophizing will be assessed using the Dutch Pain Catastrophizing Scale (PCS), which is a self-report questionnaire to evaluate the presence of catastrophic thoughts and feelings towards pain. The PCS consists of 13 items and has a maximal score of 52. Higher scores indicate higher levels of pain catastrophizing. The PCS includes three subscales; magnification (experiencing pain as a threat), rumination (repeated worrying), and helplessness (believing that nothing can resolve the pain).
Cognitive functioning	At baseline	A modified version of the behavioral listening effort test based on a dual-task paradigm by Degeest, Keppler \& Corthals (2018) will be used. The test consists of a primary and secondary task that will be administered separately (baseline condition) and simultaneously ( dual-task condition).

Trial Locations

Locations (1)

Ghent University; 🇧🇪 Gent, Oost-Vlaanderen, Belgium